Mrs. Edith Smith is a 67 year old woman with metastatic breast cancer. She has recently developed a pleural effusion that is causing her severe shortness of breath making it difficult to ambulate even within her small apartment. Most days she sits in her lazy boy chair watching TV. Once a great knitter, she is too weak to finish the sweater she is knitting for her granddaughter. Recently homecare has begun providing services to help her with her Activities of Daily Living (ADL’s) such as bathing and dressing. Her two children who live close by check in on her each day and deliver her meals but they noticed that she is eating only about half of the meals they are providing to her.

What is Mrs. Smith's PPS?

Mr. Ennoch Birchstick is a 32 year old man with AML. Despite aggressive chemotherapy, his disease has not gone into remission. He lives with his wife and two young children. They have remade their living room into a room for Ennoch because he is unable to ambulate to the bedroom he shares with his wife and he would like to be part of the day to day household activities even if he is unable to actively participate. For the past week, Ennoch has been totally bed bound, requiring total care for all of his ADL’s. While he still enjoys the food his family prepares, he is only able to eat a few bites. Mainly, he drinks Ensure throughout the day to maintain his nutrition. His is usually fully alert and oriented but is sleeping more during the day.

What stage of the PPS is Ennoch in?

“I feel distaste.

I am a scraped knee,

an old sweater with holes in the elbows

and crusty food stuck to the front.

A gray day, dull and pissy.

I am a beach stone.

The rough edges smoother by the tumble.”

What stage might this represent?

“The silence is deafening

as I approach the winter season of life.

The rose has nearly wilted

but there is a new beginning about to dawn.

As a trumpet fanfare welcomes me into a new dimension of life

as a crystal clear diamond.”

What stage might this represent?